An episiotomy is a small surgical cut in the perineum, the skin and muscle between the vagina and the anus, made to widen the opening during birth. The idea was first described in 1742 by Sir Fielding Ould, an Irish doctor, who hoped a planned cut would be safer than a ragged tear. In the early 1900s, American obstetrician Joseph DeLee argued it should be routine, especially with forceps. By the middle of the century, many hospitals cut almost every first-time mother. The cut is made in the last moments of pushing, after the area is numbed. It can run straight down the middle or angle to one side. The angled cut is less likely to reach the anus. After the baby and placenta are out, the cut is stitched closed. For decades doctors believed a clean cut healed better and protected the pelvic floor. Later studies showed routine cutting did not stop severe tears and often caused more pain, bleeding, and slow healing. Today it is used only when truly needed, such as when the baby must be born quickly, when forceps or a vacuum are used, or when a shoulder is stuck. Most births now go ahead without it.

#100policyarticles100days #85. Employer Group Waiver Plans (EGWPs). @PeterHuckfeldt and colleagues review 5 state health plans that transitioned Medicare retirees from Traditional Medicare to Medicare Advantage. 11.5% decrease in inpatient admissions. bit.ly/4fSLJ3Y

I was bracing for some sort of negative World Cup event in Atlanta, but from my perspective the whole thing rocked, everyone had a great time, and I just hope we get it back soon.

Reinvestigating the Maryland all-payer system 7 years later, it's striking how the rise of global budgeting has led people to deemphasize the rate regulation element of the model: manhattan.institute/article/…

As much as I’ll never get over that goal, I’ll also never get over the instant crowd reactions lol: - the kid going crazy - my guy going “😱” - my other guy who probably tapped and told that woman “aye, I told you what was finna happen” - the Moroccans in disbelief

#100policyarticles100days #44. Medicare Advantage Spillover. @LoyolaChicago and @urbaninstitute scholars study the spillover effects between MA and FFS. They find MA contributes to 1.3% FFS savings; highest driver is reduced outpatient spending. bit.ly/4eWJGg9

Every league in the world will be doing them within the next three years.

So I’ve been in traffic for 2 hours slowly circumnavigating the KC sports complex trying to get to the parking gate where my $150 prepaid spot is. And lots of fans are walking for miles, while shuttle buses from FanFest are backed up. FIFA screwed the logistical pooch here.

I spent two years studying the hospice industry - this isn't surprising to me at all. It's an industry overrun with bad actors taking advantage of seniors and their families in their most vulnerable moments. Ironically though, it's also full of some of the best and most caring nurses you'll ever meet. An industry badly in need of innovation.

When I worked in government, I learned a pretty simple lesson: There aren't many villains in healthcare Pharma, insurers, hospitals all respond to incentives Want different outcomes? Change the incentives its easier to find villains But changing incentives actually works